Sensors for monitoring oral appliances

ABSTRACT

Detection of a state of an oral appliance (such as an aligner, palatal expander, mandibular repositioning device, etc.) to determine if the oral appliance is functioning properly and/or if it has developed a defect.

CROSS REFERENCE TO RELATED APPLICATIONS

This patent application claims priority to U.S. Provisional PatentApplication No. 62/593,241, filed Nov. 30, 2017, titled “SENSORS FORMONITORING ORAL APPLIANCES,” which is herein incorporated by referencein its entirety.

INCORPORATION BY REFERENCE

All publications and patent applications mentioned in this specificationare herein incorporated by reference in their entirety to the sameextent as if each individual publication or patent application wasspecifically and individually indicated to be incorporated by reference.

FIELD

Described herein are oral appliances having one or more sensors, andmethods of using them.

BACKGROUND

Orthodontic procedures typically involve repositioning a patient's teethto a desired arrangement in order to correct malocclusions and/orimprove aesthetics. To achieve these objectives, orthodontic appliancessuch as braces, shell aligners, and the like can be applied to thepatient's teeth by an orthodontic practitioner. The appliance can beconfigured to exert force on one or more teeth in order to effectdesired tooth movements according to a treatment plan.

During orthodontic treatment with patient-removable appliances, theappliance may not function correctly due to a defect, or may develop adefect during use. In some instances, the appliance may be improperlyinstalled, formed, or operated by the practitioner. There is a need formethods and apparatuses that allow monitoring of a state of theintraoral appliances. Described herein are methods and apparatuses forperforming such monitoring.

SUMMARY OF THE DISCLOSURE

Described herein are apparatuses, including devices and systems,including in particular orthodontic appliances (e.g., oral appliances)and methods for monitoring an orthodontic appliance, including, but notlimited to monitoring a parameter or state of the orthodontic appliance.

In particular, described herein are oral appliances that are configuredto determine that they are properly worn and/or are properly functioningwhen worn in the user's oral cavity. Applicants note that theseapparatuses (e.g., devices and systems, which may include orthodonticaligners, mandibular repositioning apparatuses, arch expanders/palatalexpanders, etc.) may function as compliance monitors, including that apatient is wearing the apparatus and/or complying with an orthodontictreatment, but are not limited to compliance monitoring. In particular,these apparatuses may monitor how well the device is contacting thepatient's oral cavity, including teeth, gingiva, palate, etc.Alternatively or additionally, these apparatuses may be configured todetect and/or monitor wear and/or damage to the apparatus. The apparatusmay include one or more sensors (wherein a sensor may comprise a sensorreceiving and/or a sensor emitter and sensor receiver pair) providingdata to a processor; the processor may analyze, including in real time,how well the apparatus is being worn, wear on the apparatus, damage tothe apparatus, or the like. The processor may be part of the oralappliance worn by the patient or it may be in communication (wired orwireless communication, including real-time or near real-timecommunication) with the oral appliance. Thus, any of the apparatuses andmethods described herein may determine and may signal or otherwiseindicate how well the apparatus is operating.

Monitoring may alternatively or additionally include monitoring statusof the appliance, monitoring wear of the appliance, monitoring thegeographic/spatial location of the appliance, etc. In some embodiments,an orthodontic appliance includes one or more sensors configured toobtain sensor data; these sensors may include those that are indicativeof a state of the appliance. As used herein, the state of the appliancemay include, for example, how well the appliance is fitting the patientwhen worn, if the appliance has developed any damage or wear, if theappliance is defective, etc. The appliance can include one or moreprocessors operably coupled to the sensor(s) and configured to processthe sensor data so as to indicate a state of the appliance, thusenabling electronic monitoring of the appliance before and/or during aprescribed course of orthodontic treatment. Advantageously, theapparatuses (e.g., devices, systems, etc.) and methods described hereinmay improve treatment efficacy, as well as provide data useful to thepractitioner for designing and monitoring orthodontic treatments.

For example, any of the apparatuses described herein may be configuredto include one or more tooth-contacting region(s). A device formonitoring the status of an intraoral appliance may include an applianceshell comprising a plurality of teeth receiving regions (e.g., cavities)and one or more sensors operably coupled to the appliance shell andconfigured to generate sensor data indicative of a state of theappliance (e.g., where an how well the appliance is contacting theteeth, such as the presence of any gaps between the appliance and theteeth, buckling of the appliance, defects such as tears, cracks, etc. inthe appliance, and/or operating outside of a predetermined range ofparameter values), and a processor operably coupled to the one or moresensors and configured to process the sensor data so as to determineand/or indicate the state of the appliance. Sensors may be configured,for example, to determine the quality of fit of the appliance bymeasuring contact (pressure, location, etc.) between the appliance andthe oral cavity (e.g., teeth, gingiva, palate, etc.). For example,sensors may include one or more capacitive or other electrical sensorswithin or on the appliance that indicate contact between the applianceand the user's teeth. Signals from such contact sensors may be received(continuously and/or periodically) to determine when contact is beingmade with which parts of the patient's teeth and the appliance. Theprocessor may be configured to analyze the sensed data from one or moresuch sensors to determine that appropriate contact (e.g., of all or apredefined sub-set of sensors in/on the appliance) with the apparatus. Apoorly-fitting appliance may not make full contact with all of thesensors, or may make contact with a subset of sensors indicating poorcontact. The processor may also be configured to examine the intensityof the contact and may indicate that the level of the signal (indicatingcontact/non-contact) is outside of a range or threshold indicating goodcontact. The processor may record and/or transmit this information. Insome variations this information may be logged for later use by thedental professional and/or may be used to alert the patient (e.g., viadisplay on a smartphone, tablet, etc., and/or via SMS, text message, orthe like) that the appliance should be adjusted.

Thus, the apparatuses and methods described herein may be configured todetect (“smart detection”) engagement of positioning features of amandibular repositioning device, determine an expansion rate of apalatal expander, or identify a defect in an intraoral appliance. Forexample, as will be described in greater detail herein, any of theapparatuses described herein may be configured with one or more sensorsthat detect interaction between different portion of an oral applianceand/or between different oral appliances or components of an oralappliance. For example, mandibular repositioning devices may includecontact regions that engage a first oral appliance (e.g., a low archappliance) and a second oral appliance (e.g., an upper arch appliance).The apparatuses described herein may detect and determine interactionbetween the first and second oral appliances. For example suchapparatuses may monitor the bite interaction (e.g., intercuspation)between the upper and lower dental arch. Sensors on either or bothocclusal surface of the appliance may detect interaction with theopposite dental appliance, or in some variations, the teeth on theopposite arch.

As mentioned, the methods and apparatuses described herein may generallybe used with or as part of any monitoring devices for monitoring anorthodontic appliance. Monitoring may be continuous (e.g., always on) orsampled at a regular frequency (e.g., between 0.001 Hz and 1 KHz,between 1 and 120 times/hour, between 1 and 24 time/day, etc.) orsampled for a discrete time after inserting the apparatus. For example,described herein are apparatuses that may be configured to record sensordata from appliances such as orthodontic aligners.

For example, in any of these apparatuses, the data may be stored inphysical memory on the monitoring apparatus and may be retrieved byanother device in communication with the monitoring apparatus. Retrievalmay be done wirelessly, e.g., using near-field communication (NFC)and/or Bluetooth (BLE) technologies to use a smartphone or otherhand-held device to retrieve the data. Specifically described herein areorthodontic devices using them that include one or more sensors (e.g.,temperature sensor(s), capacitive sensor(s), pressure sensor(s), etc.),one or more processors (e.g., a CPU, etc.), a communication module(e.g., a NFC communication module), an antenna, and a power source(e.g., battery, etc.). A case or holder may be used to boost and/orrelay the signals from the small monitoring apparatus to a handhelddevice such as a smartphone.

In some examples, an orthodontic apparatus including (or configured as)an intraoral appliance may generally be configured to monitor a state ofan intraoral appliance, and may include a housing enclosing a powersource and monitoring circuitry, the monitoring circuitry comprising aprocessor, a memory, and one or more sensors, and an elastomericovermold encapsulating the housing. In general, any of the orthodonticdevices described herein may be sized to fit against or over one tooth.Thus, the sensor(s) and any associated electronics (memory, processor,power supplies, etc.) may be compact and configured so as not to intrudeinto the patient's oral cavity substantially. For example a housingenclosing a part of the sensor(s) or affiliated electronics may have amaximum diameter of 2 cm or less, 1.5 cm or less, 1.0 cm or less, 0.9 cmor less, 0.8 cm or less, 0.7 cm or less, 0.6 cm or less, etc.). Themonitoring apparatus housing may generally be thin (e.g., 1.0 cm orless, 0.9 cm or less, 0.8 cm or less, 0.7 cm or less, 0.6 cm or less,0.5 cm or less, 0.4 cm or less, etc.). In any of these apparatuses, themonitoring circuitry may be configured for a wired connection, e.g., mayinclude a plurality of data electrodes external to the housing.

Although the apparatuses and methods described herein include numerousexamples of near field communication (NFC), including NFC-to-NFCcommunication, any of the methods and apparatuses described herein maybe used with other types of wireless communication modes, including,without limitation, Wi-Fi, radio (RF, UHF, etc.), infrared (IR),microwave, Bluetooth (including Bluetooth low energy or BLE), magneticfield induction (including NFC), Wimax, Zigbee, ultrasound, etc. Inparticular, the methods and apparatuses described herein may includeapparatuses that convert between these different wireless modes.

For example, described herein are orthodontic appliance systemsincluding sensors (e.g., pairs of sensor emitters and sensor receivers)that detect relative position and/or orientation between the sensoremitter and sensor receiver. The sensor emitters and sensor receiverscan be used to determine a state of the orthodontic appliance (such as adeformation of the orthodontic appliance, defects in the orthodonticappliance, etc.) and/or use, e.g., compliance, of the orthodonticappliance. These orthodontic appliance systems may also be used to trackthe effectiveness of the appliance, including tracking tooth and/orpalatal movement.

For example, described herein are orthodontic appliance systemscomprising: a first orthodontic appliance shaped to receive thepatient's teeth; a sensor receiver disposed on or in the firstappliance, wherein the sensor receiver is configured to detect a signalfrom a sensor emitter on another portion of the first appliance or on asecond orthodontic appliance worn by the subject; and at least oneprocessor configured to receive sensor data from the sensor receiver andto determine a relative position, orientation or position andorientation between the sensor receiver and the sensor emitter.

For example, an orthodontic appliance system may include: an orthodonticappliance shaped to receive the patient's teeth; a sensor emitterdisposed on or in the appliance at a first location; a sensor receiverdisposed on or in the appliance at a second location, wherein the sensorreceiver is configured to detect a signal from the sensor emitter; andat least one processor configured to receive sensor data from the sensorreceiver and to determine a relative position, orientation or positionand orientation between the sensor receiver and the sensor emitter.

In any of these apparatuses, the sensor receiver and sensor emitter maybe configured to emit and detect electromagnetic energy (e.g., current,voltage, electrical field, magnetic field, etc.) and/or optical energy(e.g., light). For example, the sensor receiver may be one or more of:an optical sensor, an electromagnetic sensor, a capacitive sensor, or amagnetic sensor. The sensor emitter may be configured to emitelectromagnetic energy and/or optical energy for detection by the sensorreceiver. In some variations the same sensor may be configured as both asensor receiver and a sensor emitter. For example, a sensor emitter maybe an electrode configured to receive and/or emit electrical energy(e.g., for detection of voltage, current, capacitance, etc.).

As mentioned, any of these systems may include at least one processorthat may be disposed on or within the orthodontic appliance;alternatively the processor(s) may be located remotely. For example, theone processors may be coupled via an electrical trace on or in the firstorthodontic appliance and/or may wirelessly communicate with the sensorreceiver(s).

The first and second orthodontic appliances may be removable. Forexample, the orthodontic appliance may comprise a polymeric shell havinga plurality of teeth-receiving cavities.

Any of these systems may include a second orthodontic appliance; thesensor emitter may be on or in the second orthodontic appliance.Alternatively, the sensor emitter may be on the same (e.g., first)orthodontic appliance as the sensor receiver.

In some variations the system is configured to monitoring mandibularrepositioning. For example, the first orthodontic appliance maycomprises a first mandibular repositioning feature and the secondorthodontic appliance may comprise a second mandibular repositioningfeature; the processor may be configured to determine the relativeposition, orientation or position and orientation between the first andsecond mandibular repositioning features.

Any of these systems may include a wireless communication electronicsdisposed on or within the first orthodontic appliance, the wirelesscommunication electronics being configured to transfer the sensor datato the at least one processor.

Any of these systems may include a non-transitory computer-readablestorage medium configured to store the sensor data.

The at least one processor may be configured to indicate that theorthodontic appliance is one or more of: deformed, has a defect, is inclose proximity to the sensor receiver, and/or that the orthodonticappliance is applying a force to the patient's teeth. For example, theprocessor may be configured to detect, based on the signal received,changes in the relative positions and/or orientations of the sensorreceiver and sensor emitter; these changes may be monitored over time.In some variations the one or more processor monitors the rate of changeof the relative positions of the sensor emitter and sensor receiver.

The processor may convert signals from the sensor emitter/sensorreceiver pairs (e.g., the sensor receiver) into distances and/orintensities. For example, in some variations the processor includes amemory storing one or more look-up tables for converting sensor valuesinto distances.

In general, the orthodontic appliance may be, for example, a palatalexpander, a dental aligner, etc.

Also described herein are methods of monitoring an orthodontic applianceusing any of the apparatuses described herein. For example, a method ofmonitoring an orthodontic appliance may include: positioning a firstorthodontic appliance in the patient's mouth, so that the firstorthodontic appliance receives at least some of the patient's teeth;emitting a signal from sensor emitter within the patient's mouth;receiving the signal with a sensor receiver on or in the firstorthodontic appliance; transmitting the signal to at least oneprocessor; determining a relative position, orientation or position andorientation between the sensor receiver and the sensor emitter; andoutputting an indicator related to the relative position orientation orposition and orientation between the sensor receiver and the sensoremitter.

For example, a method for monitoring an orthodontic appliance mayinclude: positioning a first orthodontic appliance in the patient'smouth, so that the first orthodontic appliance receives at least some ofthe patient's teeth; positioning a second orthodontic appliance in thepatient's mouth, wherein the second orthodontic appliance receives atleast some of the patient's teeth; emitting a signal from sensor emitteron or in the second orthodontic appliance; receiving the signal with asensor receiver on or in the first orthodontic appliance; transmittingthe signal to at least one processor; determining, in the processor, arelative position, orientation or position and orientation between thesensor receiver and the sensor emitter; and outputting, from theprocessor, the relative position orientation or position and orientationbetween the sensor receiver and the sensor emitter.

Positioning the first orthodontic appliance may comprise positioning thefirst orthodontic appliance wherein the sensor receiver is on or in afirst mandibular repositioning feature.

Emitting the signal from a sensor emitter may comprise emitting anelectromagnetic signal or an optical signal. For example, anelectromagnetic signal may comprise one or more of: an electricalsignal, a magnetic signal, an electric current.

Any of these methods may also include positioning a second orthodonticappliance in the patient's mouth, wherein the sensor emitter is on or inthe second orthodontic appliance.

Emitting the signal may comprise emitting the signal from the sensoremitter, further wherein the sensor emitter is on or in the firstorthodontic appliance. Transmitting the signal may comprise wirelesstransmitting the signal.

Determining a relative position, orientation or position and orientationbetween the sensor receiver and the sensor emitter may compriseindicating that the orthodontic appliance is deformed, further whereinoutputting the indicator related to the relative position orientation orposition and orientation may comprise outputting that the orthodonticappliance is deformed. Determining a relative position, orientation orposition and orientation between the sensor receiver and the sensoremitter may comprise indicating that the orthodontic appliance has adefect, further wherein outputting the indicator related to the relativeposition orientation or position and orientation may comprise outputtingthat the orthodontic appliance has a defect. Determining a relativeposition, orientation or position and orientation between the sensorreceiver and the sensor emitter may comprise indicating that the sensorreceiver is in close proximity to the sensor emitter, further whereinoutputting the indicator related to the relative position orientation orposition and orientation may comprise outputting that the proximitybetween the sensor receiver and sensor emitter. In some variations,determining a relative position, orientation or position and orientationbetween the sensor receiver and the sensor emitter comprises indicatingthat the orthodontic appliance is applying a force to the patient'steeth, further wherein outputting the indicator related to the relativeposition orientation or position and orientation comprises outputtingthat the orthodontic appliance is applying a force to the patient'steeth or outputting the applied force.

An indicator related to the relative position, orientation or positionand orientation between the sensor receiver and sensor emitter mayinclude a numeric indicator (e.g., positional value, coordinates, rateof change over time, etc.) with or without units, and/or an indicatorthat the position and/or orientation between the sensor emitter andsensor receiver (or a portion of the first and/or second orthodonticappliance(s) to which they are connected) has not changed, has changed,has changed within a range or degree, etc.

Also described herein are methods, systems and apparatuses that indicateone or more states of an orthodontic appliance. For example, describedherein are orthodontic devices, comprising: an intraoral applianceshaped to receive the patient's teeth; a first sensor disposed on or inthe intraoral appliance; a second sensor disposed on or in the intraoralappliance; and at least one processor configured to receive sensor datafrom the first and second sensors and to indicate of a state of theorthodontic device based on the sensor data. The first and secondsensors comprise one or more of: a capacitive sensor, a magnetic sensor,a force sensor, a pressure sensor, and an optical sensor.

The at least one processor may be disposed on or within the intraoralappliance, as described above. The at least one processor may bedisposed on or within an electronic device remote from the orthodonticdevice. For example, the deices may include a wireless communicationelectronics disposed on or within the first intraoral appliance or thesecond intraoral appliance, the wireless communication electronics beingconfigured to transfer sensor data from the first and second sensors tothe at least one processor.

The intraoral appliance may comprise a polymeric shell having aplurality of teeth-receiving cavities. The devices may include anon-transitory computer-readable storage medium configured to storesensor data from the first and second sensors. The at least oneprocessor may be configured to indicate that the orthodontic device isdeformed. The at least one processor may be configured to indicate thatthe orthodontic device has a defect.

The at least one processor may be configured to indicate that the firstsensor is in close proximity to the second sensor. The at least oneprocessor is configured to indicate that the orthodontic device isapplying a force to the patient's teeth. The at least one processor maybe configured to indicate a position of the first sensor relative to aposition of the second sensor.

Also described herein are methods for monitoring an orthodontic device.For example, a method may include: positioning an intraoral appliance inthe patient's intraoral cavity, the intraoral appliance shaped toreceive the patient's teeth and comprising a plurality of sensors eachpositioned on or in a different part of the intraoral appliance;receiving a sensed parameter from each of the plurality of sensors; anddetermining a state of the orthodontic device based on the sensedparameters. The sensed parameter may include one or more of: acapacitance, a magnetic field, a force measurement, a voltage, and animpedance. The determining step may comprise determining if a firstportion of the intraoral appliance is aligned properly with respect to asecond portion of the intraoral appliance. The determining step maycomprise determining if the intraoral appliance is deformed.

The determining step may comprise determining if the intraoral appliancehas a defect. The determining step may comprise determining if theintraoral appliance is applying an appropriate force to the patient'steeth.

As mentioned above, any of these methods and apparatuses may beconfigured to monitor mandibular repositioning using an orthodonticappliance. For example, determining the correct interaction betweenmandibular repositioning features of an appliance.

A mandibular repositioning system may include: a first intraoralappliance shaped to receive the patient's upper teeth and comprising afirst mandibular repositioning feature; a first sensor disposed on or inthe first mandibular repositioning feature; a second intraoral applianceshaped to receive the patient's lower teeth and comprising a secondmandibular repositioning feature; a second sensor disposed on or in thesecond mandibular repositioning feature; at least one processorconfigured to receive sensor data from either or both the first andsecond sensors to detect contact between the first and second mandibularrepositioning features. The first and second sensors may include one ormore of: capacitive sensors, magnetic sensors, force sensors, pressuresensors, and optical sensors.

The at least one processor may be disposed on or within the firstintraoral appliance or the second intraoral appliance. The at least oneprocessor may be disposed on or within an electronic system remote fromthe first and second intraoral appliances. Any of these systems mayinclude wireless communication electronics disposed on or within thefirst intraoral appliance or the second intraoral appliance, thewireless communication electronics being configured to transfer sensordata from the first and second sensors to the at least one processor.

The first and second intraoral appliances may comprises a polymericshell having a plurality of teeth-receiving cavities.

In some variations the system further includes a third sensor disposedon or in the first mandibular repositioning feature; a fourth sensordisposed on or in the second mandibular repositioning feature; whereinthe first sensor is disposed on a first side of the first mandibularrepositioning feature, the third sensor is disposed on a second side ofthe first mandibular repositioning feature, the second sensor isdisposed on a first side of the second mandibular repositioning feature,and the fourth sensor is disposed on a second side of the secondmandibular repositioning feature; and wherein the at least one processoris configured to receive sensor data from the first, second, third, andfourth sensors to detect proper positioning when the first sensorcontacts the second sensor, and to detect reverse positioning when thethird sensor contacts the fourth sensor.

Also described herein are methods for monitoring a mandibularrepositioning system, the method comprising: receiving sensed parametersfrom a first plurality of sensors of a first orthodontic appliance wornin a patient's mouth and a second plurality of sensors of a secondorthodontic appliance worn in a patient's mouth, wherein the firstorthodontic appliance is shaped to receive the patient's upper teeth andcomprises the first plurality of sensors on or adjacent to a firstpositioning feature of the first intraoral appliance, further whereinthe second orthodontic appliance is shaped to receive the patient'slower teeth and comprises the second plurality of sensors on or adjacentto a second positioning feature of the second intraoral appliance; anddetermining engagement between the first positioning feature and thesecond positioning feature based on the sensed parameter.

Also described herein are apparatuses (devices and systems) formonitoring palatal expansion by detecting movement/separation of thepalatal suture, including detecting while applying force to expand thepalatal suture. For example, described herein are palatal expanderdevices comprising: a palatal expander body comprising a palatal regionand a tooth-receiving region configured to receive teeth of thepatient's upper arch; a sensor disposed on or in the palatal region ofthe palatal expander body; at least one processor configured to receivesensor data from the sensor and to determine an expansion state of apatient's palatal region based on the sensor data. The sensor maycomprises one or more of: a force sensor, an optical sensor, a straingauge, a capacitive electrode. The at least one processor may bedisposed on or within the palatal expander body.

The at least one processor may be disposed on or within an electronicdevice remote from the palatal expander device. Any of these devices mayinclude wireless communication electronics disposed on or within thefirst intraoral appliance or the second intraoral appliance, thewireless communication electronics being configured to transfer sensordata from the sensor to the at least one processor. The palatal expanderbody may comprise a polymeric shell having a plurality ofteeth-receiving cavities. The at least one processor may evaluate a sizeof a mid palatine suture of the patient based on the sensor data. Forexample, the at least one processor may determine a change indeformation of the palatal expander device based on the sensor data. Insome variations, the at least one processor determines an expansionforce of the palatal expander device based on the sensor data.

Also described herein are methods of monitoring palatal expansion, themethod comprising: receiving sensor data from one or more sensors on apalatal expander device, as the palatal expander device is worn by apatient, wherein the palatal expander device comprises a palatalexpander body including a palatal region and a tooth-receiving region,wherein the one or more sensors are on or in the palatal region;monitoring, in one processors, the sensor data from the sensor todetermine an expansion state of a patient's palate based on the sensordata; and outputting an indicator of the expansion state of thepatient's palate.

Receiving sensor data may comprise receiving sensor data from one ormore sensors comprises receiving sensor data from a pair of sensorspositioned opposite the patient's palatal suture. Receiving sensor datamay comprise receiving sensor data from one or more sensors comprisesreceiving sensor data from one or more optical sensors.

Receiving sensor data may comprise receiving sensor data from one ormore sensors comprises receiving sensor data from one or more capacitivesensors. Monitoring may comprise monitoring over a time period ofgreater than one day (e.g., more than: 24 hours, 36 hours, 48 hours, 3days, 4 days, 5 days, etc.). Monitoring may be continuous (e.g., atperiodic intervals, e.g. 100 Hz, 10 Hz, 1 Hz, 1/min, every 2 min, every3 min, every 5 min, every 10 min, every 30 min, every hour, etc.) or atdiscrete intervals (e.g., when requested by a user, etc.). As mentioned,any of these methods may include wirelessly transmitting the sensor datato the one or more processors.

BRIEF DESCRIPTION OF THE DRAWINGS

The novel features of the invention are set forth with particularity inthe claims that follow. A better understanding of the features andadvantages of the present invention will be obtained by reference to thefollowing detailed description that sets forth illustrative embodiments,in which the principles of the invention are utilized, and theaccompanying drawings of which:

FIG. 1A illustrates an example of a tooth repositioning appliance.

FIGS. 1B-1D shows an example of a tooth repositioning system.

FIG. 2 illustrates a method of orthodontic treatment using a pluralityof appliances.

FIG. 3 schematically illustrates an example of a monitoring apparatus(shown as an ECI device).

FIG. 4 illustrates a flowchart showing a method for monitoring anorthodontic device.

FIG. 5A shows a first example of an apparatus including an alignerappliance configured to determine and/or monitor a state of the aligner.

FIG. 5B shows a second example of an apparatus including a pair of(upper arch, lower arch) aligners configured to determine the state ofthe aligner.

FIGS. 6A-6B illustrate one embodiment of an orthodontic devicecomprising a mandibular repositioning device.

FIGS. 6C-6E show an example of a mandibular repositioning device thatcan detect both proper engagement and reverse engagement of positioningfeatures.

FIG. 7 is an example of portion of a mandibular repositioning apparatusincluding an engagement feature having a pair of sensors (e.g.,capacitive sensors).

FIGS. 7A-7B illustrate operation of the sensors of the mandibularrepositioning apparatus shown in FIG. 7 (enlarged) configured to assessdevice quality.

FIG. 8 illustrates a dental appliance with sensors that can detectdefects in the appliance.

FIG. 9A is an example of a scan through a patient's head, showing athickness of palate mucosa at the mid palatine raphe; in somevariations, the apparatuses described herein may be configured aspalatal expanders including one or more sensors. The sensors may beconfigured to determine the thickness of this mid palatine raphe regionand/or the status of the palatal expander.

FIG. 9B is an example of a palatal expander apparatus that may beadapted to include one or more sensors for determining a property of thepalate and/or the status of the palatal expander, as described herein.

FIGS. 10A-10F show examples of a palatal expander device that caninclude any number or type of sensor to determine an expansion state ofthe palatal expander device based on sensor data.

DETAILED DESCRIPTION

The orthodontic apparatuses described herein are configured to determinea state of the orthodontic apparatus based on sensor data. The state ofthe orthodontic apparatus typically refers to how well device isoperating. For example the state of the orthodontic device may refer tothe state of the orthodontic appliances's patient contact, including theextent and/or duration of contact with relevant portions of a patient'soral cavity (teeth, gingiva, palate, etc.) and/or contact with anotherorthodontic apparatus or another region of the orthodontic apparatus.The state of the orthodontic apparatus may alternatively or additionallyrefer to the state of integrity of the orthodontic appliance, includingdetecting and/or monitoring any damage or defects in the device (e.g.,breakages, tears, cavities, etc.).

Any of the apparatuses described herein may be configured to monitor oneor more of: the operation (including status, e.g., operational status)of an orthodontic appliance, and/or to monitor the user compliance forwearing an appliance, and/or to monitor the overall wear or condition ofan orthodontic appliance, and/or to monitor the interaction between anappliance with the patient's anatomy, e.g., teeth, gingiva, palate, etc.

Generally, these apparatuses include one or more orthodontic applianceand one or more sensors on the orthodontic appliance that are configuredto detect one or more parameters that may be used to determine the stateof the orthodontic apparatus. The one or more sensors may be configuredbased on their position on and/or in the orthodontic appliance, and/orbased on their shape and size, and/or based on the type of sensor. Anyappropriate type of sensor may be used, including: electrical sensors(e.g., detecting capacitance, conductance, etc.), force sensors (e.g.,detecting pressure, strain, etc.), thermal sensors, etc. Examples ofsensors are provided herein. The sensors may be embedded within theorthodontic apparatus and oriented to sense properties of theorthodontic appliance directly, rather than the patient. For example,the sensors may be oriented away from the patient, toward the body ofthe orthodontic appliance.

Any of these apparatuses may include one or more processors configuredto communicate with the one or more sensors. The processor(s) may beattached to and/or integral with the orthodontic appliance. For examplethe processor may receive sensor input from one or more of the sensorsand may send control commands to activate/deactivate and/or modulate thesensors. The processor may control the timing of sensing. The processormay regulate the power. The processor may also include or be connectedto a memory for storing the data (raw data and/or processed data). Theprocessor may also be functionally connected to a communications module(e.g., wireless communications circuitry, such as Bluetooth, WiFi,etc.).

As will be described in greater detail below, the processor may analyzethe sensor data from the one or more sensors to determine the state ofthe orthodontic apparatus. The analysis of the sensor data may beperformed on the one or more processors attached to (on or in) theorthodontic appliance, or the one or more processors (including anadditional off-appliance processor) may be used to analyze or furtheranalyze the data to determine a state of the orthodontic appliance.

For example, an orthodontic apparatus may record sensor data from anintraoral appliance, such as dental/orthodontic aligners, includingshell aligners. Data recorded by the orthodontic device may be stored inphysical memory on the device and may be retrieved by another device. Inparticular, the data described may be retrieved by a hand heldelectronics communication device such as a smartphone, tablet, or thelike. The handheld electronic device may include a user interface toaugment communication between the orthodontic device and the electronicdevice, and may provide feedback to the user (e.g., patient) and/ortechnician, physician, dentist, orthodontist, or other medical/dentalpractitioner. Once transmitted to the handheld device, the data may beprocessed (or further processed) and/or passed on to a remote processor,memory and/or server.

As mentioned, the apparatuses and methods described herein formonitoring an orthodontic appliance (e.g., a removable intraoralappliances) may generate sensor data related to the intraoral appliance.The sensor data can be processed and analyzed to determine whether theappliance is functioning properly or has a defect. Additionally, thesensor data may be used to provide information about the state of thedevice. Advantageously, the apparatuses and methods described herein mayprovide an integrated electronic sensing and logging system capable ofgenerating more reliable and accurate patient compliance data, which maybe used by the treating practitioner to track the state of theorthodontic device and improve treatment efficacy. Additionally, theorthodontic devices described herein may provide high value sensing datauseful for appliance design. In some embodiments, the sensing dataprovided by the orthodontic devices described herein may be used asfeedback to modify parameters of an ongoing orthodontic treatment, alsoknown as adaptive closed-loop treatment planning. For example,information about the contact between the appliance and the patient'soral cavity and/or about defects or wear in an appliance may be used todetermine if a replacement or modified version of the appliance shouldbe used.

As mentioned, in any of the methods and apparatuses described herein,all or some of the sensor data of the state of the orthodontic devicemay be used as feedback into a treatment plan, including the treatmentplan in which the appliance from which the sensor data was collected ispart of. For example, sensor data indicating the relative change inposition and/or orientation of one or more portions of the appliance maybe used to estimate and/or approximate movement of all or some of thepatient's dentition, and this information may be used to modify thetreatment plan, including the duration of one or more stages, themodification of one or more current and/or future stages, or the like.Any of these methods and apparatuses may provide feedback to a patientand/or user (e.g., doctor, dentist, orthodontist, technician, etc.) onthe performance of the appliance and/or treatment plan. Feedback may bereported and/or implemented in real time or after some time delay.

In any of the methods and apparatuses described herein, the use of theone or more sensors for detecting a state of the orthodontic device maybe used to refine a treatment plan. Refining of the treatment plan mayinclude reducing or eliminating the number of modifications to anoriginal treatment plan and/or an extension of the treatment planduration (overall or incremental duration of one or more stages). Forexample, the use of one or more sensors to detect a state of theorthodontic device may provide feedback that may be used to adjust thetreatment plan or one or more stages of the treatment plan on the fly,which may reduce the total overall number of adjustments necessary. Insome variations, a treatment plan may be adjusted based on sensor dataof a state of the orthodontic device to adjust further, subsequentlyworn, orthodontic appliances; if the sensor data indicates, for example,that a portion of the aligner is under strain or stress beyond anexpected value, this may indicate that a tooth, group of teeth and/orpalatal region are not moving in response to the force(s) being appliedby the appliance(s). Thus, the system or apparatus may adjust thetreatment plan accordingly, e.g., by wearing the appliance until theforces on the appliance and/or the relative positions or orientations of(all or regions of) the appliance are within a determined range, and/orby providing additional appliances that may address the change from anexpected value.

An orthodontic apparatus may be any orthodontic device, system or thelike, including in particular orthodontic appliances such as aligners,palatal expanders and/or mandibular repositioning apparatus. Theorthodontic apparatuses described herein may be removable (e.g.,removably by the patient) or they may be attached (e.g., by a dentalprofessional). An orthodontic apparatus may include multiple orthodonticappliances, including an upper arch appliance and a lower archappliance. In some variations the apparatuses and methods describedherein may detect the interaction between multiple separate orthodonticappliances. Examples of each of these variations are described in detailbelow.

The various embodiments described herein can be used as part of or incombination with various types of intraoral appliances worn in apatient's mouth. The intraoral appliance may be an orthodonticappliance, such as an aligner or wire-and-bracket appliance, used toreposition one or more of the patient's teeth to a desired arrangement,e.g., to correct a malocclusion. Alternatively or additionally, theintraoral appliance may be used to maintain one or more of the patient'steeth in a current arrangement, such as a retainer. Other examples ofintraoral appliances suitable for use in conjunction with theembodiments herein include, mouth guards, mandibular repositioningdevices, and palatal expanders.

Appliances having teeth receiving cavities that receive and mayreposition teeth, e.g., via application of force, are generallyillustrated with regard to FIG. 1A. FIG. 1A illustrates an exemplarytooth repositioning appliance or aligner 100 that can be worn by apatient in order to achieve an incremental repositioning of individualteeth 102 in the jaw. The appliance can include a shell havingteeth-receiving cavities that receive and resiliently reposition theteeth. An appliance or portion(s) thereof may be indirectly fabricatedusing a physical model of teeth. For example, an appliance (e.g.,polymeric appliance) can be formed using a physical model of teeth and asheet of suitable layers of polymeric material. In some embodiments, aphysical appliance is directly fabricated, e.g., using rapid prototypingfabrication techniques, from a digital model of an appliance.

Although appliances such as the ones shown in FIGS. 1A-1D may bereferred to as polymeric shell appliances, the embodiments disclosedherein are well suited for use with many appliances that receive teeth,for example appliances without one or more of polymers or shells, orwith partial tooth-receiving regions. The appliance can be fabricatedwith one or more of many materials such as metal, glass, reinforcedfibers, carbon fiber, composites, reinforced composites, aluminum,biological materials, and combinations thereof for example. Theappliance can be shaped in many ways, such as with thermoforming ordirect fabrication (e.g., 3D printing, additive manufacturing), forexample. Alternatively or in combination, the appliance can befabricated with machining such as an appliance fabricated from a blockof material with computer numeric control machining.

An appliance can fit over all teeth present in an upper or lower jaw, orless than all of the teeth. The appliance can be designed specificallyto accommodate the teeth of the patient (e.g., the topography of thetooth-receiving cavities matches the topography of the patient's teeth),and may be fabricated based on positive or negative models of thepatient's teeth generated by impression, scanning, and the like.Alternatively or additionally, the appliance can be a generic applianceconfigured to receive the teeth, but not necessarily shaped to match thetopography of the patient's teeth. In some cases, only certain teethreceived by an appliance will be repositioned by the appliance whileother teeth can provide a base or anchor region for holding theappliance in place as it applies force against the tooth or teethtargeted for repositioning. In some embodiments, some, most, or even allof the teeth may be repositioned at some point during treatment. Teeththat are moved can also serve as a base or anchor for holding theappliance as it is worn by the patient. Typically, no wires or othermeans will be provided for holding an appliance in place over the teeth.In some cases, however, it may be desirable or necessary to provideindividual attachments or other anchoring elements 104 on teeth 102 withcorresponding receptacles or apertures 106 in the appliance 100 so thatthe appliance can apply a selected force on the tooth. Exemplaryappliances, including those utilized in the Invisalign® System, aredescribed in numerous patents and patent applications assigned to AlignTechnology, Inc. including, for example, in U.S. Pat. Nos. 6,450,807,and 5,975,893, as well as on the company's website, which is accessibleon the World Wide Web (see, e.g., the URL “invisalign.com”). Examples oftooth-mounted attachments suitable for use with orthodontic appliancesare also described in patents and patent applications assigned to AlignTechnology, Inc., including, for example, U.S. Pat. Nos. 6,309,215 and6,830,450.

Appliances such as the ones shown in FIG. 1A may also be used as aplatform or support for other oral appliances that do not move teeth (ormove teeth in addition to other therapeutic effect), but may, forexample, adjust bite or re-shape the palate. For example a mandibularrepositioning apparatus may include a pair of body regions alsoincluding a tooth-receiving cavities within shell-like structures (onefor the upper jaw, one for the lower jaw) that are configured to secureover or onto a patient's teeth. The tooth-receiving portion may providesupport against which other regions, such as positioning features, maybrace. Similarly, a palatal expander apparatus may include one or moretooth-receiving portions in addition to a palatal region configured tobe adjacent to the patient's palate.

FIGS. 1B-1D illustrate an example of a tooth repositioning system 110(configured as a series of aligners) including a plurality of appliances112, 114, 116. Any of the appliances described herein can be designedand/or provided as part of a set of a plurality of appliances used in atooth repositioning system. Each appliance may be configured so atooth-receiving cavity has a geometry corresponding to an intermediateor final tooth arrangement intended for the appliance. The patient'steeth can be progressively repositioned from an initial tootharrangement to a target tooth arrangement by placing a series ofincremental position adjustment appliances over the patient's teeth. Forexample, the tooth repositioning system 110 can include a firstappliance 112 corresponding to an initial tooth arrangement, one or moreintermediate appliances 114 corresponding to one or more intermediatearrangements, and a final appliance 116 corresponding to a targetarrangement. A target tooth arrangement can be a planned final tootharrangement selected for the patient's teeth at the end of all plannedorthodontic treatment. Alternatively, a target arrangement can be one ofsome intermediate arrangements for the patient's teeth during the courseof orthodontic treatment, which may include various different treatmentscenarios, including, but not limited to, instances where surgery isrecommended, where interproximal reduction (IPR) is appropriate, where aprogress check is scheduled, where anchor placement is best, wherepalatal expansion is desirable, where restorative dentistry is involved(e.g., inlays, onlays, crowns, bridges, implants, veneers, and thelike), etc. As such, it is understood that a target tooth arrangementcan be any planned resulting arrangement for the patient's teeth thatfollows one or more incremental repositioning stages. Likewise, aninitial tooth arrangement can be any initial arrangement for thepatient's teeth that is followed by one or more incrementalrepositioning stages.

The various embodiments of the orthodontic appliances presented hereincan be fabricated in a wide variety of ways. As an example, someembodiments of the appliances herein (or portions thereof) can beproduced using indirect fabrication techniques, such as by thermoformingover a positive or negative mold. Indirect fabrication of an orthodonticappliance can involve producing a positive or negative mold of thepatient's dentition in a target arrangement (e.g., by rapid prototyping,milling, etc.) and thermoforming one or more sheets of material over themold in order to generate an appliance shell. Alternatively or incombination, some embodiments of the appliances herein may be directlyfabricated, e.g., using rapid prototyping, stereolithography, 3Dprinting, and the like.

The configuration of the orthodontic appliances herein can be determinedaccording to a treatment plan for a patient, e.g., a treatment planinvolving successive administration of a plurality of appliances forincrementally repositioning teeth. Computer-based treatment planningand/or appliance manufacturing methods can be used in order tofacilitate the design and fabrication of appliances. For instance, oneor more of the appliance components described herein can be digitallydesigned and fabricated with the aid of computer-controlledmanufacturing devices (e.g., computer numerical control (CNC) milling,computer-controlled rapid prototyping such as 3D printing, etc.). Thecomputer-based methods presented herein can improve the accuracy,flexibility, and convenience of appliance fabrication.

In some embodiments, orthodontic appliances, such as the applianceillustrated in FIG. 1A, when properly worn, may impart forces to thecrown of a tooth and/or an attachment positioned on the tooth at one ormore points of contact between a tooth receiving cavity of the applianceand received tooth and/or attachment. The magnitude of each of theseforces and/or their distribution on the surface of the tooth candetermine the type of orthodontic tooth movement which results. Toothmovements may be in any direction in any plane of space, and maycomprise one or more of rotation or translation along one or more axes.Types of tooth movements include extrusion, intrusion, rotation,tipping, translation, and root movement, and combinations thereof, asdiscussed further herein. Tooth movement of the crown greater than themovement of the root can be referred to as tipping. Equivalent movementof the crown and root can be referred to as translation. Movement of theroot greater than the crown can be referred to as root movement.

FIG. 2 illustrates a method 200 of orthodontic treatment using aplurality of appliances, in accordance with embodiments. The method 200can be practiced using any of the appliances or appliance sets describedherein. In step 210, a first orthodontic appliance is applied to apatient's teeth in order to reposition the teeth from a first tootharrangement to a second tooth arrangement. In step 220, a secondorthodontic appliance is applied to the patient's teeth in order toreposition the teeth from the second tooth arrangement to a third tootharrangement. The method 200 can be repeated as necessary using anysuitable number and combination of sequential appliances in order toincrementally reposition the patient's teeth from an initial arrangementto a target arrangement. The appliances can be generated all at the samestage or time point, in sets or batches (e.g., at the beginning of oneor more stages of the treatment), or one at a time, and the patient canwear each appliance until the pressure of each appliance on the teethcan no longer be felt or until the maximum amount of expressed toothmovement for that given stage has been achieved. A plurality ofdifferent appliances (e.g., a set) can be designed and even fabricatedprior to the patient wearing any appliance of the plurality. Afterwearing an appliance for an appropriate period of time, the patient canreplace the current appliance with the next appliance in the seriesuntil no more appliances remain. The appliances are generally notaffixed to the teeth and the patient may place and replace theappliances at any time during the procedure (e.g., patient-removableappliances). The final appliance or several appliances in the series mayhave a geometry or geometries selected to overcorrect the tootharrangement. For instance, one or more appliances may have a geometrythat would (if fully achieved) move individual teeth beyond the tootharrangement that has been selected as the “final.” Such over-correctionmay be desirable in order to offset potential relapse after therepositioning method has been terminated (e.g., permit movement ofindividual teeth back toward their pre-corrected positions).Over-correction may also be beneficial to speed the rate of correction(e.g., an appliance with a geometry that is positioned beyond a desiredintermediate or final position may shift the individual teeth toward theposition at a greater rate). In such cases, the use of an appliance canbe terminated before the teeth reach the positions defined by theappliance. Furthermore, over-correction may be deliberately applied inorder to compensate for any inaccuracies or limitations of theappliance.

Predictable and effective tooth movement using an aligner such as thosedescribed above, however, may depend implicitly on good contact betweenthe patient's teeth and the aligner. Thus, treatment efficacy may dependat least partially on fit, and the ability of the patient to properlywear the device, as well as the integrity of the apparatus itself. Thus,the methods and apparatuses described herein, which may detect andmonitor these parameters, may improve patient treatment and outcomes.

An intraoral appliance can be operably coupled to a monitoring deviceconfigured to provide data related to a state of the intraoralappliance. Alternatively or in combination, the monitoring device can beconfigured to provide data indicative of one or more characteristics ofthe device, such as electrical parameters, elasticity, defects such asair bubbles or cracks, force applied by the appliance, or deformationsof the appliance. The characteristics of the intraoral appliance candetermine a state of the appliance.

The apparatuses described herein may include the oral appliance (e.g.,aligner, palatal expander, etc.) and a status-monitoring sub-systemincluding one or more of: sensors, processor, memory, communicationscircuitry (including an antenna), clock, power source (e.g., battery,capacitor, inductor, etc.), and connections and/or circuitry tocommunicate and/or coordinate between these components. Thestatus-monitoring sub-system may be at least partially integrated intothe oral appliance. For example, an apparatus as described herein can beconfigured for use in the patient's intraoral cavity by locating andsizing the monitoring sub-system for use within the oral cavity. Forexample, the dimensions of a monitoring device may be limited in orderto avoid patient discomfort and/or facilitate integration into anintraoral appliance as discussed below. In some embodiments, amonitoring device has a height or thickness less than or equal to about1.5 mm, or less than or equal to about 2 mm. In some embodiments, amonitoring device has a length or width less than or equal to about 4mm, or less than or equal to about 5 mm. The shape of the monitoringdevice can be varied as desired, e.g., circular, ellipsoidal,triangular, square, rectangular, etc. For instance, in some embodiments,a monitoring device can have a circular shape with a diameter less thanor equal to about 5 mm.

FIG. 3 schematically illustrates an orthodontic apparatus 300 includingan intraoral appliance configured to be worn on one or more of thepatient's teeth, gingiva, and/or palate 301 and a status-monitoringsub-system 302. The status-monitoring sub-system may include anelectronics module (“ECI”) 303 that connects or interfaces with one ormore sensor(s) on the appliance. The orthodontic apparatus 300 can beused in combination with any embodiment of the systems and devicesdescribed herein, and the components of the orthodontic apparatus 300may be equally applicable to any other embodiment of the orthodonticapparatuses described herein. All or a portion of the status-monitoringsub-system 303 of the orthodontic apparatus 300, such as the electronicsmodule 303 can be implemented as an application-specific integratedcircuit (ASIC) including one or more of: a processor 302, a memory 304,a clock 308, a communication unit 310, an antenna 312, a powermanagement unit 314, or a power source 316. One or more sensors 306, maybe included as part of (e.g., integrated with) the electronics, or itmay be separate, and may be connected by one or more electric traces(e.g., wires or other traces). The processor 302 (e.g., a centralprocessing unit (CPU), microprocessor, field programmable gate array(FPGA), logic or state machine circuit, etc.), also referred to hereinas a controller, can be configured to perform the various methodsdescribed herein. The memory 304 encompasses various types of memoryknown to those of skill in the art, such as RAM (e.g., SRAM, DRAM), ROM(EPROM, PROM, MROM), or hybrid memory (e.g., flash, NVRAM, EEPROM), andthe like. The memory 304 can be used to store instructions executable bythe processor 302 to perform the methods provided herein. Additionally,the memory can be used to store sensor data obtained by the sensor(s)306, as discussed in greater detail below.

The orthodontic apparatus 300 can include any number of sensors 306,such as one, two, three, four, five, or more sensors. In someembodiments, the use of multiple sensors provides redundancy to increasethe accuracy and reliability of the resultant data. Some or all of thesensors 306 can be of the same type. Some or all of the sensors 306 canbe of different types. Examples of sensor types suitable for use in themonitoring devices described herein include: touch or tactile sensors(e.g., capacitive, resistive), proximity sensors, audio sensors (e.g.,microelectromechanical system (MEMS) microphones), color sensors (e.g.,RGB color sensors), electromagnetic sensors (e.g., magnetic reedsensors, magnetometer), light sensors, force sensors (e.g.,force-dependent resistive materials), pressure sensors, temperaturesensors, motion sensors (e.g., accelerometers, gyroscopes), vibrationsensors, piezoelectric sensors, strain gauges, pH sensors, conductivitysensors, gas flow sensors, gas detection sensors, humidity or moisturesensors, physiological sensors (e.g., electrocardiography sensors,bio-impedance sensors, photoplethysmography sensors, galvanic skinresponse sensors), or combinations thereof. In some embodiments, thesensors herein can be configured as a switch that is activated and/ordeactivated in response to a particular type of signal (e.g., optical,electrical, magnetic, mechanical, etc.).

In any of the apparatuses and methods described herein a sensor may beconfigured to sensor or detect change in the orientation of theappliance and/or of one or more region of the appliance relative to oneor more other regions of the appliance. For example, a sensor may be agyroscope (e.g., a microelectromechanical systems (“MEMS”) gyroscope orany other appropriate gyroscope and/or accelerometer, and/or any otherappropriate motion sensor.

A sensor 306 can be located at any portion of an intraoral appliance,such as at or near a distal portion, a mesial portion, a buccal portion,a lingual portion, a gingival portion, an occlusal portion, or acombination thereof. A sensor 306 can be embedded within theappliance(s), including in any of these regions or portions. Inembodiments where multiple sensors 306 are used, some or all of thesensors can be located at different portions of the appliance and/orintraoral cavity. Alternatively, some or all of the sensors 306 can belocated at the same portion of the appliance and/or intraoral cavity.

An analog-to-digital converter (ADC) (not shown) can be used to convertanalog sensor data into digital format, if desired. The processor 302can process the sensor data obtained by the sensor(s) 306 in order todetermine appliance usage and/or patient compliance, as describedherein. The sensor data and/or processing results can be stored in thememory 304. Optionally, the stored data can be associated with atimestamp generated by the clock 308 (e.g., a real-time clock orcounter).

The orthodontic apparatus 300 may include a communication unit 310configured to transmit the data stored in the memory (e.g., sensor dataand/or processing results) to a remote device. The communication unit310 can utilize any suitable communication method, such as wired orwireless communication methods (e.g., RFID, near-field communication,Bluetooth, ZigBee, infrared, etc.). The communication unit 310 caninclude a transmitter for transmitting data to the remote device and anantenna 312. Optionally, the communication unit 310 includes a receiverfor receiving data from the remote device. In some embodiments, thecommunication channel utilized by the communication unit 310 can also beused to power the device 300, e.g., during data transfer or if thedevice 300 is used passively.

The remote device can be any computing device or system, such as amobile device (e.g., smartphone), personal computer, laptop, tablet,wearable device, etc. Optionally, the remote device can be a part of orconnected to a cloud computing system (“in the cloud”). The remotedevice can be associated with the patient, the treating practitioner,medical practitioners, researchers, etc. In some embodiments, the remotedevice is configured to process and analyze the data from the monitoringapparatus 300, e.g., in order to monitor patient compliance and/orappliance usage, for research purposes, and the like.

The orthodontic apparatus 300 can be powered by a power source 316, suchas a battery. In some embodiments, the power source 316 is a printedand/or flexible battery, such as a zinc-carbon flexible battery, azinc-manganese dioxide printed flexible battery, or a solid-state thinfilm lithium phosphorus oxynitride battery. The use of printed and/orflexible batteries can be advantageous for reducing the overall size ofthe status-monitoring sub-system of the orthodontic apparatus 300 andavoiding patient discomfort. For example, printed batteries can befabricated in a wide variety of shapes and can be stacked to makethree-dimensional structures, e.g., to conform the appliance and/orteeth geometries. Likewise, flexible batteries can be shaped to lieflush with the surfaces of the appliance and/or teeth. Alternatively orin combination, other types of batteries can be used, such assupercapacitors. In some embodiments, the power source 316 can utilizelower power energy harvesting methods (e.g., thermodynamic,electrodynamic, piezoelectric) in order to generate power for theorthodontic device 300. Optionally, the power source 316 can berechargeable, for example, using via inductive or wireless methods. Insome embodiments, the patient can recharge the power source 316 when theappliance is not in use. For example, the patient can remove theintraoral appliance when brushing the teeth and place the appliance onan inductive power hub to recharge the power source 316.

Optionally, the orthodontic apparatus 300 can include a power managementunit 314 connected to the power source 316. The power management unit314 can be configured to control when the status-monitoring sub-systemof the apparatus 300 is active (e.g., using power from the power source316) and when the device 300 is inactive (e.g., not using power from thepower source 316). In some embodiments, the orthodontic apparatus 300 isonly active during certain times so as to lower power consumption andreduce the size of the power source 316, thus allowing for a smallerstatus-monitoring sub-system 302. In some embodiments, the orthodonticapparatus 300 includes an activation mechanism (not shown) forcontrolling when the status monitoring sub-system of the orthodonticapparatus 300 is active (e.g., powered on, monitoring appliance usage)and when the status monitoring sub-system of the orthodontic apparatus300 is dormant (e.g., powered off, not monitoring appliance usage). Theactivation mechanism can be provided as a discrete component of theorthodontic device 300, or can be implemented by the processor 302, thepower management unit 314, or a combination thereof. The activationmechanism can be used to reduce the amount of power used by theorthodontic apparatus 300, e.g., by inactivating the device 300 when notin use, which can be beneficial for reducing the size of the powersupply 316 and thus the overall device size.

A sensor (or any other part of the status-monitoring sub-system) can beoperably coupled to the intraoral appliance in a variety of ways. Forexample, the sensor can be physically integrated with the intraoralappliance by coupling the sensor to a portion of the appliance (e.g.,using adhesives, fasteners, latching, laminating, molding, etc.), and/orembedding it within the apparatus (e.g., at the time of forming theapparatus or afterwards. For example, the coupling may be a releasablecoupling allowing for removal of the monitoring device from theappliance, or may be a permanent coupling in which the monitoring deviceis permanently affixed to the appliance. Alternatively or incombination, the sensor can be physically integrated with the intraoralappliance by encapsulating, embedding, printing, or otherwise formingthe monitoring device with the appliance. In some embodiments, theappliance includes a shell shaped to receive the patient's teeth, andthe sensor is physically integrated with the shell. The sensor can belocated on an inner surface of the shell (e.g., the surface adjacent tothe received teeth), an outer surface of the shell (e.g., the surfaceaway from the received teeth), or within a wall of the shell.Optionally, as discussed further herein, the shell can include areceptacle shaped to receive the sensor.

An orthodontic apparatus as described herein can include an intraoralappliance shaped to receive the patient's teeth, a first sensor disposedon or in the intraoral appliance, a second sensor disposed on or in theintraoral appliance, and at least one processor configured to receivesensor data from the first and second sensors and to indicate of a stateof the orthodontic device based on the sensor data.

In general, the processor may be adapted or otherwise configured toreceive and process the sensor data and use this sensor data todetermine one or more parameters of the state of the orthodonticappliance that is part of the apparatus, such as the state of theorthodontic appliance's patient contact and/or the state of theorthodontic appliance's integrity. The processor may includenon-volatile memory that contains instructions (e.g. software, firmware,etc.) for executing any of the steps described herein, includingcontrolling the sensor(s) and receiving sensor data, and/or processingthe data to determine a state of the appliance (e.g., the state ofintegrity of the appliance or the quality of contact with the patient).For example, the at least one processor can be configured to indicatethat the orthodontic device is broken, worn, and/or deformed.Additionally, the processor can be configured to indicate that theorthodontic device has a defect. In some examples, the at least oneprocessor is configured to indicate that the orthodontic device isapplying an appropriate force to the patient's teeth. Additionally, theat least one processor can be configured to indicate a position of thefirst sensor relative to a position of the second sensor.

In any of the apparatuses described herein, the apparatus may determineif a first region (corresponding to a first sensor) is within apredetermined distance of a second region (corresponding to a secondsensor), indicating the apparatus is being correctly worn and/oroperated. For example, if the orthodontic device is a mandibularrepositioning device, the processor can be configured to indicate thatthe first sensor is in close proximity to the second sensor, therebydetermining if positioning features of the device are properly engaged.

FIG. 4 illustrates a flowchart 400 showing an example of a method formonitoring an orthodontic apparatus to determine a state of anorthodontic appliance forming part of the apparatus (e.g., a state ofthe orthodontic appliance's patient contact and/or the state of theorthodontic appliance's state of integrity. At step 402 of flowchart400, the method can include positioning an intraoral apparatus in thepatient's intraoral cavity. The intraoral apparatus can include anappliance be shaped to receive the patient's teeth and can comprise aplurality of sensors each positioned within the intraoral appliance tosense a characteristic of the appliance. In some examples, the intraoralappliance is a dental aligner. The apparatus may include an upper archaligner configured to receive the patient's upper teeth, and a lowerarch aligner configured to receive the patient's lower teeth. In anotherexample, the intraoral apparatus can include a mandibular repositioningappliance (e.g., device). The mandibular repositioning apparatus caninclude repositioning features configured to engage one another. In yetanother example, the intraoral appliance can comprise a palatal expanderdevice.

At step 404 of flowchart 400, the method can further include receiving asensed value from each of the plurality of sensors. The sensed value canbe a parameter sensed by any of a number of different types of sensors.For example, a capacitive sensor may provide a capacitance value, amagnetic sensor may provide an orientation or magnitude of a magneticfield, an optical sensor may provide an output current corresponding tosensed light intensity (at a particular frequency or range offrequencies), a force sensor or strain gauge may provide a force value,and an ultrasonic sensor may provide the duration of a return pulse.These sensed values may be transmitted to a processor in the appliance(or separate from the appliance) and used to determine parameterindicating the state of the appliance. For example, at step 406 offlowchart 400, the method can include determining a state of theorthodontic device based on the sensed values. For example, in oneexample the determining step comprises determining if a first portion ofthe intraoral appliance is aligned properly with respect to a secondportion of the intraoral appliance. In another example, the determiningstep comprises determining if the intraoral appliance is deformed. Inyet another example, the determining step comprises determining if theintraoral appliance has a defect. In an additional example, thedetermining step comprises determining if the intraoral appliance isapplying an appropriate force to the patient's teeth. In anothervariation, determining includes determining if the appliance is properlyseated on the patient's teeth, gingiva and/or palate. In any of theapparatuses (devices and systems) described herein, one or more opticalsensors may be used to detect movement and/or position of one or moreregions of the apparatus relative to other regions. For example, anoptical sensor may be used to detect expansion of a palatalexpander/arch expander.

One the processor has determined one or more parameters indicative ofthe state of the apparatus, the apparatus may transmit the state of theapparatus 408 and/or the parameters to a remote device for display,storage and/or further transmission. For example the apparatus maytransmit to a mobile device held by the patient (e.g., phone,smartphone, tablet, etc.) and/or to a dental professional (dentist,orthodontist, etc.).

FIG. 5 shows a first example of an apparatus comprising an orthodonticdevice configured to determine, monitor and indicate a state of theorthodontic device. In this example the orthodontic device is an aligner(e.g., a shell aligner) that is shaped to receive the patient's teeth.The aligner 550 includes a tooth-receiving region 551. This toothreceiving region may be a channel configured to substantially conform tothe patient's teeth. The channel may have connected chambers eachcomprising a negative impression of one of the patient's teeth (buccal,lingual and occlusal sides). The chambers may be formed from a scan orimpression of the patient's teeth, and may be arranged so as to applyforce to reposition one or more of the patient's teeth when worn. Inthis example, the apparatus may be configured to detect and/or monitorand/or indicate the state of the aligner, and more specifically, thestate of the orthodontic appliance's patient contact. As shown in FIG.5A, a plurality of sensors 553 are shown within the occlusal channel ofthe tooth-receiving region 551. These sensors are configured to detectcontact or proximity with a tooth received in each region (e.g.,chamber) of the aligner. For example, each sensor may include acapacitive sensor, or a pair of electrodes configured to detectcapacitance; proximity to the sensor(s) may be detected by the sensorwhich may each return a value (e.g., a voltage or current level based onthe capacitance detected) corresponding to the proximity of a tooth whenthe apparatus is being worn. In operation, this arrangement, in whichsensors configured as proximity or contact sensors are arranged in thedeepest part of the tooth-receiving region 551, as shown in FIG. 5A, mayprovide a range of values that may be used to determine if the aligneris fully and properly seated on all of the patient's teeth. Thesesensors may be pairs of sensor emitters and sensor receivers, or theymay be combined emitters/receivers. In some variations sensor emittersmay be adjacent to sensor receivers.

The apparatus in FIG. 5A may also include any of the sub-systems fordetermining the state of the orthodontic appliance (e.g., aligner). InFIG. 5A, for example, the apparatus includes the plurality of sensors553, that are each connected (via a conductive trace, wire, etc.) to ahousing 555 enclosing one or more of: processor, memory, communicationscircuitry (e.g., antenna), clock, power source (e.g., battery,capacitor, inductor, etc.). Although capacitive sensors (touch sensors)are shown in FIG. 5A, any appropriate type of sensor may be used, ormultiple types of sensors.

In FIG. 5A, the processor(s) may be configured to receive values(capacitance values) from the sensor(s), and may control applying energyto the sensors to determine the capacitance values. The processor mayprocess the individual sensors for an array of different positionscorresponding to different teeth and/or regions of the aligner. Thearray of values may be compared to a threshold value or range of valuesto determine how well the tooth/teeth are seated at each position. Thevalues may be normalized by one or more normalization sensors 557 (e.g.,additional touch sensors) located more laterally (e.g., lingually orbuccally) on the aligner. Thus, the processor may be configured toreceive sensor data from the first and second sensors and to indicate ofa state of the orthodontic device based on the sensor data. The state ofthe aligner may indicate that the aligner is well seated (with the touchsensors are above a threshold value), poorly seated (which may be asingle value or a gradation of values, depending on how deeply the teethare seated in some or all of the chambers forming the tooth-receivingregion), or unseated (when not worn). Thus, although the complianceinformation (worn/not worn) may be provided by this apparatus, theseapparatuses may also provide a great deal of additional informationabout how well the apparatus may be operating, including how well thedevice is seated or applied. In some variations the parametersindicating the state of the aligner may include a map showing how wellthe appliance is/was seated over the dental arch; a time course forseating information may be recorded and reviewed (e.g., over a singlenight/days use, etc.).

FIG. 5B is another example of an apparatus configured to determine thestate of one or more appliances forming the apparatus. In FIG. 5B, theapparatus includes a pair of aligners, an upper arch 561 aligner and alower arch 563 aligner. This apparatus may be configured to detectintercuspation between the upper and lower aligners. In this example,the lower aligner 563 includes a plurality of sensors 565 that maydetect contact with predetermined locations on the upper aligner. Forexample the upper aligner may also include a plurality of sensors 565′that, when a particular specific intercuspation is achieved, may returna value. In some variations the upper sensors 565′ may be sensoremitters and the lower sensors 565 may be sensor receivers (or viceversa); in some variations a mixture of complementary sensor receiversand sensor emitters may be distributed between the upper and lowerappliances. In some variations compound sensors (e.g., both sensoremitter/sensor receiver sensors) may be used. The value(s) may betracked (as an array, correlated to location) and may be determined overtime. The processor may analyze the values to determine the quality ofthe contact between the upper and lower jaws when wearing the aligners.As in FIG. 5A, either or both upper and lower aligners may include anyof the sub-systems for determining the state of the orthodonticappliance (in this example, intercuspation between the two appliances),which may be duplicated between the two aligners, or may be divviedbetween them. In FIG. 5B separate housings 575, 575′ may encloseseparate processors, power sources, etc. and these two sub-systems maycommunicate with each other.

FIGS. 6A-6B illustrate one embodiment of an orthodontic apparatus asdescribed herein comprising a mandibular repositioning appliance 500.The mandibular repositioning appliance 500 can comprise first and secondintraoral appliances 502, 504 (which may be part of a shell alignerconfigured to secure to the teeth and/or may reposition them, and may beconfigured to receive the patient's upper and lower teeth, respectively.Each of the intraoral appliances may include a positioning feature 506,506′ that are configured to engage with each other. The interactionbetween the positioning features may drive the jaw (e.g., the patient'slower jaw) to provide orthodontic effect. At least one positioningfeature in the apparatus may include at least one sensor 508. In FIG.6A, both the upper and lower positioning features include sensors. Thesesensors may detect contact and/or proximity between the oppositepositioning features, and provide information on the proper functioningof the apparatus, e.g., engagement between the positioning features fromthe correct sides/locations. In FIG. 6A, the orthodontic apparatus canfurther include at least one processor and any of the additionalcomponents of the sensing sub-systems, as described in more detailabove.

FIG. 6B is an alternative view of a first or upper appliance 502′ for anintraoral apparatus 500′, including a positioning feature 506. Thepositioning feature can include a sensor 508; in this example, thesensor includes two portions (e.g., a pair of electrodes 518, 518′). Thesensor can be any type of sensor as described herein. For example, thesensor can be a capacitive sensor, a magnetic sensor, a force sensor, apush button sensor, a resistive sensor. As mentioned above, thesesensors may be configured as sensor emitters/sensor receivers or pairsof sensor emitters/sensor receivers.

Referring back to FIG. 6A, the sensors of the first and second intraoralappliances can provide sensor data to the processor. The processor canbe configured to use the sensor data to determine a state of themandibular repositioning apparatus. For example, the sensor data can beused to determine if the positioning features of the first and secondintraoral appliances are properly engaged. Sensors on the matingsurfaces of the positioning features can detect contact between theupper and lower positioning features. More sophisticated sensors candetect distance between the positioning features, in addition tocontact.

FIGS. 6C-6E show an example of a mandibular repositioning apparatus 500″that can detect both proper engagement of positioning features, asdescribed above (and shown in FIG. 6D), and reverse engagement, as shownin FIG. 6E. In the example of FIG. 6C sensors 528, 528′, 538, 538′ arepositioned on opposite sides of the positioning features 506. FIGS. 6Dand 6E illustrate operation of a mandibular repositioning apparatus. InFIGS. 6D and 6E sensors 548, 548′ and 558, 558′ are located on eitherside of each positioning feature 506, 506′. The processor can thendetermine which of the sensors are in contact or in close proximity todetermine if the mandibular repositioning device is properly engaged(FIG. 6D) or reverse engaged (FIG. 6E).

The sensors of the mandibular repositioning apparatus can furthercomprise additional sensors, such as sensors configured as complianceindicators (e.g., temperature sensors or accelerometers to give anindication of head position and whether the appliances are being worn,etc.). The processor(s) may be configured to use the additionalcompliance indicators to determine that engagement is being assessedonly when the appliances are worn by the patient. The mandibularrepositioning apparatus 500 may therefore be configured to detectcompliance and proper use by detecting engagement of the positioningfeatures while the appliances are being worn by the patient.

FIG. 7 illustrates another example of a portion of a mandibularrepositioning apparatus, including a sensor (configured as a pair ofelectrodes 708, 708′). Referring to FIGS. 7A-7B, the sensor 708, 708′ ofan orthodontic apparatus can also be used to assess device quality(e.g., structural integrity, defects, etc.). For example, largeunsupported thermoformed features, like the mandibular positioningfeatures of FIGS. 6A-6E, may deform during treatment. Sensors (such ascapacitive sensors) can be used to detect the deformation of theintraoral appliance. Referring to FIG. 7A, the appliance can include oneor more capacitive sensors 708, 708′ that sense static electric fieldlines 710. In FIG. 7B, the capacitive sensors are able to detect changesin the electric field that the processor may use to determine that theappliance is bent or deformed by sensing changes to the static electricfield lines.

Additionally, the sensors can be used to detect defects within theappliance, such as air bubbles or cracks. Referring to FIG. 8, sensors808 in the appliance can detect the relative permittivity; the processorreceiving this value may, over time, detect changes in the relativepermittivity of the appliance material resulting from air bubbles orcracks in the appliance. The processor may include one or morethresholds indicating use and/or defect. In FIG. 8, the defects 712 areinclusions or manufacturing defects; defects may develop with use and/orwith storage, including delamination of different layers of the device,tearing of the device, inclusion of air bubbles, etc. These defects maynegatively impact the appliance performance and/or fit. In somevariations the appliance may include a material that may adversely takeup water (saliva), particularly in regions that are supposed to remainsealed off. For example, a sealed region for holding electricalcomponents (batteries, wires, electronics, etc.) may be inadvertentlyopened, exposing it to saliva; one or more sensors may detect thisfailure mode and alert the patient and/or caregiver. In variationsincluding a mandibular repositioning feature, for example, a cavity orregion of the appliance (e.g., in a hollow region) may collect saliva,which may be undesirable (e.g., allowing bacterial growth, etc.). One ormore sensors may detect the collection of fluid. Alternatively oradditionally, any of these apparatuses may include one or more sensorsconfigured to detect bacterial growth or other contamination.

In any of these variations, the appliance may include one or moretemperature sensors that may be used to monitor storage temperature. Atemperature sensor on the device may be configured to monitortemperature of the device to indicate that the storage temperature doesnot exceed a range for safe storage (e.g., greater than 120 degrees F.,greater than 125 degrees F., greater than 130 degrees F., greater than140 degrees F., greater than 150 degrees F., greater than 160 degreesF., greater than 170 degrees F., etc., and/or less than 50 degrees F.,less than 40 degrees F., less than 30 degrees F., less than 20 degreesF., less than 10 degrees F., less than 5 degrees F., less than 0 degreesF., etc.).

Thus, the apparatuses and methods described herein may be used with anyone or more of the palatal expanders and/or arch expanders. For example,the methods and apparatuses described herein may generally be used tomonitor the operation (including status, e.g., operational status) of anappliance including, but not limited to a palatal expander, and/or tomonitor the user compliance for wearing an appliance including, but notlimited to a palatal expander, and/or to monitor the overall wear orcondition of an orthodontic appliance, including, but not limited to apalatal expander and/or to monitor the interaction between an applianceincluding, but not limited to a palatal expander, with the patient'sanatomy, e.g., teeth, gingiva, palate, etc.

FIGS. 9A-9B illustrate a palatal expander that may be configured tomonitor and/or determined compliance (e.g., patient compliance inwearing the apparatus) and/or the state of the appliance. For example,FIG. 9A illustrates a scan through a patient's head, showing mucosatissue at the mid palatine raphe (arrow). In this region, the tissue maybe very thin and the apparatuses described herein may be configured todetermine the palatal suture opening stages using a capacitiveelectrode. For example, an electrostatic field may be formed bycapacitive electrodes at the soft palate region. Using this technique, apalatal expander can be monitored during the treatment without need totake CTs. FIG. 9B shows an example of a palatal expander formed, similarto an aligner, to include a tooth-retaining region 903 (regions oneither side of the device may be configured to conform to a patient'smolars and/or premolars) and a palatal region 905 that may be configuredto sit adjacent to the palate and apply force on the lingual side of theteeth and/or lateral palate to spread the suture.

FIGS. 10A-10F show examples of a palatal expander device 1000 that caninclude any number or type of sensor(s) 1008 to monitor the operation ofthe palatal expander, to monitor the user compliance for wearing thepalatal expander, to monitor the overall wear or condition of thepalatal expander, and/or to monitor the interaction between the palatalexpander and the patient's anatomy. Any of these sensors may beconfigured as sensor emitters and/or sensor receivers as describedherein.

For example, FIG. 10A illustrates a section through an exemplary palatalexpander 1000 worn on a subject's dental arch 1009, including regionworn on the teeth 1011. In this example, the sensors (two pairs ofsensors 1007, 1008 are shown) may be used to determine an expansionstate of the palatal expander device based on sensor data. In FIG. 10A,the sensor pairs may detect compliance for wearing the palatal expander;either or both the first sensor pair 1007 and the second sensor pair1007 may be capacitive sensors that can detect a change in the fieldbetween any of the sensors in the pair(s). Thus, for example, when thepatient is wearing the palatal expander the sensor(s), which may beelectrodes, may determine a change in the capacitance across the pairsconsistent with the dental tissue, as compared to air or just water.Alternatively, in some variations the palatal expander may detect achange in the capacitance between an electrode in the first pair 1007and an electrode in the second pair 1008 that may indicate a change inthe structural integrity of the palatal expander. Any of the apparatusesmay include a data processing unit (e.g., an electronic module, notshown) that connects to the sensor(s) and may provide power and receiveand/or process signals from the sensors. The electronic monitor(s) maylog the data (e.g., be configured as a data logger), process the dataand/or transmit the data, e.g., to a remote processor, including aremote server. The apparatus, including a data processing unit may storeand/or monitor the use of the appliance over time, including alertingthe user, a caregiver and/or the patient if the appliance is not beingworn for a prescribed duration.

FIG. 10B illustrates an example of a palatal expander apparatusincluding one or more sensors configured to monitor the interactionbetween the palatal expander and the patient's anatomy. In FIG. 10B, thesensor may comprise an optical sensor 1008′ (e.g., including in somevariations an emitter and a detector) that may determine one or more of:the distance to the tissue (e.g., the palate), and/or the sutureopening, based on light contrast between soft-hard tissue and/or theblood stream. In some variations, an ultrasonic sensor may be used. Theapparatus, including any data processing unit (not shown) may storeand/or monitor a change in the relationship between the patient's tissueand the appliance over time. For example the apparatus may monitor themovement/expansion of the palatal suture opening as the palatal expanderoperates, and/or the change in the distance between the apparatus andthe palate over time. This data may be analyzed locally (e.g., in thedata processing unit) or remotely and may be used as feedback to thepatient, user and/or caregiver and/or may be used as feedback into anorthodontic treatment plan, including modifying an orthodontic treatmentplan.

The palatal expander device 1000 of FIG. 10C shows another example of anapparatus including a sensor for detecting the relationship between theapparatus and the patient's tissue. As mentioned, this sensor maycomprise a plurality of capacitive electrodes, and/or in somevariations, the sensor may include an optical sensor (e.g., an opticalreceiver 1008″ and an optical transmitter 1008′″), as shown. Thisapparatus may be configured to detect the extent of the mucosa tissue atthe mid palatine raphe, allowing the processor to detect the mid palatalsuture opening when the sensor applied an electrostatic field using thecapacitive electrodes on the appliance, positioned opposite from thesoft palate region, as described in FIG. 10B. Using this technique thepalatal expansion can be monitored during the treatment without need totake CTs. In general, the apparatuses and methods described herein, inparticular the palatal expanders, may allow direct monitoring, in realtime, of the suture.

FIG. 10D is an example of a palatal expander apparatus configured tomonitor the operation of the palatal expander. In FIG. 10D, a sensor1018 may include one or more capacitive electrodes configured to providevalues that can be used by the processor to monitor the change in thedeformation of palatal expander; this information may be used, e.g., todetermine how much and at what rate the expansion happens. This can bemeasured by tracking the change of capacity measured between thecapacitive sensor electrodes in the expander device. The sensor may bepositioned on palatal expander in a way that the distance between thecapacitive electrodes changes while the expansion happens. For example,the sensor 1018 can be placed midline of trans-palatal segment.Ultrasonic sensors can also be used an alternative to capacitiveelectrodes to track the expansion of the palatal expander. Alternativelyor additionally, in some variations the sensor(s) may be configured tomeasure the operation of the apparatus to determine if the palatalexpander includes an breaks, cracks, wear, etc., and my thus monitor theoverall wear or condition of the palatal expander.

Thus, any of the apparatuses described herein may be configured todetect a failure (e.g., failure mode) of the apparatus, such as apalatal expander apparatus. For example, a palatal expander such asthose described herein, may fail if the palatal region deforms under theforce (pressure) exerted on the apparatus when inserted into thepatient's mouth. One or more sensors on the apparatus, such as thosedescribed in reference to FIG. 10D, may detect the deformation, based,e.g., on the position of various regions of the device relative to eachother, such as the position of the left half of the palatal regionrelative to the right half.

FIG. 10F illustrates another example of a palatal expander apparatusconfigured to monitor the operation of the palatal expander. The deviceshown in FIG. 10F may be used to directly detect the force applied bythe apparatus, e.g., if no force is applied or if lower than an expectedthreshold (e.g., lower than 8 N) is being applied. In FIG. 10F, theapparatus includes a sensor 1028, such as a strain gauge, that detectsstain on the palatal expander, or a region of the palatal expander, suchas, e.g., the palatal region configured to be worn adjacent to thepatient's palate. In some variations the forces acting on the apparatusmay be stored, analyzed and/or transmitted by a data processing unit(not shown); for example the apparatus may be configured to monitorforce across the apparatus which may be representative of the forcesapplied by the patient's teeth and/or palatal region when the device isworn; it may be expected that as the patient's teeth and palate adjustsand adapts to the appliance, these forces may be reduced in an expectedmanner, e.g., within a predictable fashion. Thus, the sensor values maybe analyzed to determine a change in the values over time, indicative ofwear (e.g., compliance, when the device is worn in the patient's mouth)and/or operation of the appliance, e.g., when the appliance is movingthe teeth and/or palate. The rate of change in the force(s) applied maybe within a predicted range indicating effective treatment, or outsideof the predicted range (lower, and/or in some cases higher) thanexpected may indicate a problem in the treatment, particularly if theabsolute force applied is higher than an expected value.

In some of these apparatuses, the one or more sensors may be configuredto detect compliance (e.g., patient wearing of the apparatus) when thesensor(s) are directed to infer wearing of the device based on thechange in sensor value(s) when monitoring the sensor itself. This may beparticularly beneficial as compared to direct compliance measurements,in which the relationship between the apparatus and the patient, andparticularly a sensor and the patient, may be variable, making reliablecontact difficult; the internal anatomy of the mouth, including teeth,gingiva and palate, may be complex, making some sensors, such as flatelectrodes, difficult to reliably operate. The method and apparatusesdescribed herein may avoid these problems. In general, the variationsdescribed herein that may be used to monitor or measure compliance, mayalso be configured to monitor the quality of the compliance, includinghow well the apparatus is worn, or fit, in the patient's mouth. Improperfit may be detected from the sensor values, if they are outside ofexpected parameter ranges, particularly when wearing the device.

Referring to FIGS. 10E and 10F, a sensor may be, e.g., a strain gauge orforce sensors and can be placed at force application regions, such asthe lingual side of crowns, or the palatal contact regions, to monitorexpansion force of the palatal expander device. The sensor data from thestrain gauges or force sensors can be used to determine an expansionstate of the device.

In some of these apparatuses, the one or more sensors may be configuredto detect compliance (e.g., patient wearing of the apparatus) when thesensor(s) are directed to infer wearing of the device based on thechange in sensor value(s) when monitoring the sensor itself. This may beparticularly beneficial as compared to direct compliance measurements,in which the relationship between the apparatus and the patient, andparticularly a sensor and the patient, may be variable, making reliablecontact difficult; the internal anatomy of the mouth, including teeth,gingiva and palate, may be complex, making some sensors, such as flatelectrodes, difficult to reliably operate. The method and apparatusesdescribed herein may avoid these problems. In general, the variationsdescribed herein that may be used to monitor or measure compliance, mayalso be configured to monitor the quality of the compliance, includinghow well the apparatus is worn, or fit, in the patient's mouth. Improperfit may be detected from the sensor values, if they are outside ofexpected parameter ranges, particularly when wearing the device. Any ofthe apparatuses described herein may be, for, example, configured todetect a retention force of an appliance (e.g., aligner, palatalexpander, etc.) on the patient's teeth.

When a feature or element is herein referred to as being “on” anotherfeature or element, it can be directly on the other feature or elementor intervening features and/or elements may also be present. Incontrast, when a feature or element is referred to as being “directlyon” another feature or element, there are no intervening features orelements present. It will also be understood that, when a feature orelement is referred to as being “connected”, “attached” or “coupled” toanother feature or element, it can be directly connected, attached orcoupled to the other feature or element or intervening features orelements may be present. In contrast, when a feature or element isreferred to as being “directly connected”, “directly attached” or“directly coupled” to another feature or element, there are nointervening features or elements present. Although described or shownwith respect to one embodiment, the features and elements so describedor shown can apply to other embodiments. It will also be appreciated bythose of skill in the art that references to a structure or feature thatis disposed “adjacent” another feature may have portions that overlap orunderlie the adjacent feature.

Terminology used herein is for the purpose of describing particularembodiments only and is not intended to be limiting of the invention.For example, as used herein, the singular forms “a”, “an” and “the” areintended to include the plural forms as well, unless the context clearlyindicates otherwise. It will be further understood that the terms“comprises” and/or “comprising,” when used in this specification,specify the presence of stated features, steps, operations, elements,and/or components, but do not preclude the presence or addition of oneor more other features, steps, operations, elements, components, and/orgroups thereof. As used herein, the term “and/or” includes any and allcombinations of one or more of the associated listed items and may beabbreviated as “/”.

Spatially relative terms, such as “under”, “below”, “lower”, “over”,“upper” and the like, may be used herein for ease of description todescribe one element or feature's relationship to another element(s) orfeature(s) as illustrated in the figures. It will be understood that thespatially relative terms are intended to encompass differentorientations of the device in use or operation in addition to theorientation depicted in the figures. For example, if a device in thefigures is inverted, elements described as “under” or “beneath” otherelements or features would then be oriented “over” the other elements orfeatures. Thus, the exemplary term “under” can encompass both anorientation of over and under. The device may be otherwise oriented(rotated 90 degrees or at other orientations) and the spatially relativedescriptors used herein interpreted accordingly. Similarly, the terms“upwardly”, “downwardly”, “vertical”, “horizontal” and the like are usedherein for the purpose of explanation only unless specifically indicatedotherwise.

Although the terms “first” and “second” may be used herein to describevarious features/elements (including steps), these features/elementsshould not be limited by these terms, unless the context indicatesotherwise. These terms may be used to distinguish one feature/elementfrom another feature/element. Thus, a first feature/element discussedbelow could be termed a second feature/element, and similarly, a secondfeature/element discussed below could be termed a first feature/elementwithout departing from the teachings of the present invention.

Throughout this specification and the claims which follow, unless thecontext requires otherwise, the word “comprise”, and variations such as“comprises” and “comprising” means various components can be co-jointlyemployed in the methods and articles (e.g., compositions and apparatusesincluding device and methods). For example, the term “comprising” willbe understood to imply the inclusion of any stated elements or steps butnot the exclusion of any other elements or steps.

In general, any of the apparatuses and methods described herein shouldbe understood to be inclusive, but all or a sub-set of the componentsand/or steps may alternatively be exclusive, and may be expressed as“consisting of” or alternatively “consisting essentially of” the variouscomponents, steps, sub-components or sub-steps.

As used herein in the specification and claims, including as used in theexamples and unless otherwise expressly specified, all numbers may beread as if prefaced by the word “about” or “approximately,” even if theterm does not expressly appear. The phrase “about” or “approximately”may be used when describing magnitude and/or position to indicate thatthe value and/or position described is within a reasonable expectedrange of values and/or positions. For example, a numeric value may havea value that is +/−0.1% of the stated value (or range of values), +/−1%of the stated value (or range of values), +/−2% of the stated value (orrange of values), +/−5% of the stated value (or range of values), +/−10%of the stated value (or range of values), etc. Any numerical valuesgiven herein should also be understood to include about or approximatelythat value, unless the context indicates otherwise. For example, if thevalue “10” is disclosed, then “about 10” is also disclosed. Anynumerical range recited herein is intended to include all sub-rangessubsumed therein. It is also understood that when a value is disclosedthat “less than or equal to” the value, “greater than or equal to thevalue” and possible ranges between values are also disclosed, asappropriately understood by the skilled artisan. For example, if thevalue “X” is disclosed the “less than or equal to X” as well as “greaterthan or equal to X” (e.g., where X is a numerical value) is alsodisclosed. It is also understood that the throughout the application,data is provided in a number of different formats, and that this data,represents endpoints and starting points, and ranges for any combinationof the data points. For example, if a particular data point “10” and aparticular data point “15” are disclosed, it is understood that greaterthan, greater than or equal to, less than, less than or equal to, andequal to 10 and 15 are considered disclosed as well as between 10 and15. It is also understood that each unit between two particular unitsare also disclosed. For example, if 10 and 15 are disclosed, then 11,12, 13, and 14 are also disclosed.

Although various illustrative embodiments are described above, any of anumber of changes may be made to various embodiments without departingfrom the scope of the invention as described by the claims. For example,the order in which various described method steps are performed mayoften be changed in alternative embodiments, and in other alternativeembodiments one or more method steps may be skipped altogether. Optionalfeatures of various device and system embodiments may be included insome embodiments and not in others. Therefore, the foregoing descriptionis provided primarily for exemplary purposes and should not beinterpreted to limit the scope of the invention as it is set forth inthe claims.

The examples and illustrations included herein show, by way ofillustration and not of limitation, specific embodiments in which thesubject matter may be practiced. As mentioned, other embodiments may beutilized and derived there from, such that structural and logicalsubstitutions and changes may be made without departing from the scopeof this disclosure. Such embodiments of the inventive subject matter maybe referred to herein individually or collectively by the term“invention” merely for convenience and without intending to voluntarilylimit the scope of this application to any single invention or inventiveconcept, if more than one is, in fact, disclosed. Thus, althoughspecific embodiments have been illustrated and described herein, anyarrangement calculated to achieve the same purpose may be substitutedfor the specific embodiments shown. This disclosure is intended to coverany and all adaptations or variations of various embodiments.Combinations of the above embodiments, and other embodiments notspecifically described herein, will be apparent to those of skill in theart upon reviewing the above description.

What is claimed is:
 1. An orthodontic appliance system, the systemcomprising: a first orthodontic appliance having teeth-receivingcavities shaped to receive a patient's teeth; at least two sensorreceivers disposed on or in the first orthodontic appliance, whereineach of the at least two sensor receivers is configured to detect asignal from a corresponding sensor emitter of at least two sensoremitters on another portion of the first orthodontic appliance or on asecond orthodontic appliance worn by the patient; and at least oneprocessor configured to receive sensor data from the at least two sensorreceivers and to determine a relative position, orientation or positionand orientation between the at least two sensor receivers and the atleast two sensor emitters.
 2. The system of claim 1, wherein the atleast two sensor receivers comprise one or more of: an optical sensor,an electromagnetic sensor, a capacitive sensor, or a magnetic sensor. 3.The system of claim 1, wherein the at least one processor is disposed onor within the first orthodontic appliance.
 4. The system of claim 1,wherein the at least one processor is coupled via an electrical trace onor in the first orthodontic appliance.
 5. The system of claim 1, whereinthe first orthodontic appliance is removable.
 6. The system of claim 1,further comprising the second orthodontic appliance, wherein the atleast two sensor emitters are on or in the second orthodontic appliance.7. The system of claim 6, wherein the first orthodontic appliancecomprises a first mandibular repositioning feature and the secondorthodontic appliance comprises a second mandibular repositioningfeature, wherein the processor is configured to determine the relativeposition, orientation or position and orientation between the first andsecond mandibular repositioning features.
 8. The system of claim 1,further comprising wireless communication electronics disposed on orwithin the first orthodontic appliance, the wireless communicationelectronics being configured to transfer the sensor data to the at leastone processor.
 9. The system of claim 1, wherein the first orthodonticappliance comprises a polymeric shell having a plurality of theteeth-receiving cavities.
 10. The system of claim 1, further comprisinga non-transitory computer-readable storage medium configured to storethe sensor data.
 11. The system of claim 1, wherein the at least oneprocessor is configured to indicate that the first orthodontic applianceis deformed.
 12. The system of claim 1, wherein the at least oneprocessor is configured to indicate that the first orthodontic appliancehas a defect.
 13. The system of claim 1, wherein the at least oneprocessor is configured to indicate that the at least two sensoremitters are in close proximity to the corresponding at least two sensorreceivers.
 14. The system of claim 1, wherein the at least one processoris configured to indicate that the first orthodontic appliance isapplying a force to the patient's teeth.
 15. The system of claim 1,wherein the first orthodontic appliance comprises a palatal expander,the palatal expander including a palatal region coupled to theteeth-receiving cavities and configured to apply a force laterallyacross the patent's palate.
 16. The system of claim 1, wherein the firstorthodontic appliance comprises a dental aligner configured toresiliently reposition one or more of the patient's teeth.
 17. Thesystem of claim 1, wherein each of the at least two sensors isconfigured to detect contact or proximity with a tooth received in acorresponding cavity of the first orthodontic appliance.
 18. The systemof claim 1, wherein the at least two sensor receivers are disposed on orin different tooth receiving cavities of the first orthodonticappliance.
 19. An orthodontic appliance system, the system comprising:an orthodontic appliance having teeth-receiving cavities shaped toreceive a patient's teeth; at least two sensor emitters disposed on orin the orthodontic appliance; at least two sensor receivers disposed onor in different teeth-receiving cavities of the orthodontic appliance,wherein each of the at least two sensor receivers is configured todetect a signal from a corresponding sensor emitter of the at least twosensor emitters; and at least one processor configured to receive sensordata from the sensor receiver and to determine a relative position,orientation or position and orientation between the at least two sensorreceivers and the at least two sensor emitters.
 20. The system of claim19, wherein the at least two sensor emitters and the at least two sensorreceivers are combined emitters/receivers.
 21. The system of claim 19,wherein the at least two sensor emitters are disposed on or in differenttooth receiving cavities of the orthodontic appliance.
 22. The system ofclaim 19, wherein each of the at least two sensor emitters or each ofthe at least two sensor receivers is configured to detect contact orproximity with a tooth received in a corresponding cavity of theorthodontic appliance.
 23. The system of claim 19, wherein theorthodontic appliance comprises a dental aligner configured toresiliently reposition one or more of the patient's teeth.
 24. Thesystem of claim 19, wherein the at least one processor is disposed on orwithin the orthodontic appliance.
 25. An orthodontic device, comprising:an intraoral appliance having teeth-receiving cavities shaped to receiveand reposition a patient's teeth; a first sensor disposed on or in afirst cavity of the teeth-receiving cavities of the intraoral appliance;a second sensor disposed on or in a second cavity of the teeth-receivingcavities of the intraoral appliance; and at least one processorconfigured to receive sensor data from the first and second sensors andto indicate of a state of the orthodontic device based on the sensordata.
 26. The device of claim 25, wherein the first and second sensorscomprise one or more of: a capacitive sensor, a magnetic sensor, a forcesensor, a pressure sensor, and an optical sensor.
 27. The device ofclaim 25, wherein the at least one processor is disposed on or withinthe intraoral appliance.
 28. The device of claim 25, wherein the firstsensor is configured to detect contact or proximity with a first toothreceived in the first cavity, and wherein the second sensor isconfigured to detect contact or proximity with a second tooth receivedin the first cavity.